Getting the Poop on Parkinson’s

Charlie Nimivitz sang that it’s “getting hard to poop and pee” in his song, My New Reality in his Awkward Dance CD.

Joel Davis wrote about it in his story, I Knew the Drill.

The rest of us with Parkinson’s Disease (PD) don’t talk much about it. It is not exactly dinner table conversation. But I’m ready to tackle this taboo topic: constipation or rather, the lack of poop, and Parkinson’s.

Kathrynne Holden, MS, RD, Parkinson Nutrition Specialist, defines constipation as having fewer than three bowel movements per week. It occurs when bowel movements become difficult or less frequent. Going longer than three days without a bowel movement causes the stool to harden and become more difficult to pass. I meet the constipation criteria with twice-a-week-like-clockwork bowel movements.

So what’s the big deal about constipation? Granted, at first it can be uncomfortable and just a nuisance. But prolonged constipation can result in fecal impaction, a condition where dry, hard feces accumulate in the colon and cannot be passed. This can be very painful and may require hospitalization and possibly surgery.

There are several reasons why constipation occurs so frequently in PD patients. The PD meds often lead to constipation by slowing the movement of food through the GI track. The absorption of the PD meds can be slowed and benefits minimized due to constipation. Also, PD may cause some degeneration of the nerves of the GI track. In addition, few people drink enough fluids or eat enough fiber to combat constipation.

Tips on managing constipation can be found at the following question and answer forum from:

Kathrynne Holden, MS, RD
Parkinson Nutrition Specialist
Nutrition You Can Live With
http://www.nutritionucanlivewith.com

Q: I suffer from severe constipation as a result of my Parkinson medication. It is an ordeal for me. I’ve tried many over the counter remedies (milk of magnesia, suppositories, laxatives, etc.). Is there anything that might be easier on my system?

A: You are right to be concerned. Long-term use of suppositories and laxatives can actually worsen chronic constipation, so that a temporary problem becomes permanent; milk of magnesia can cause loss of important electrolytes over time.

Be sure that you are drinking enough fluids each day, at least 6-8 glasses, to help keep the stool soft. And be sure to get plenty of high-fiber foods, like whole-wheat bread and crackers, high-fiber cereals, and unprocessed vegetables and fruits. Try some prunes or prune juice once or twice a week. Prunes are a good source of fiber, and both prunes and their juice contain a natural laxative. Get as much exercise as you are able – walking is very good. Exercise seems to stimulate the colon and keep the stool moving along.

If none of these practices work, then you should talk to your doctor about safe, appropriate stool softeners and laxatives.

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Other Resources:

Ask the Parkinson Dietician
http://forum.parkinson.org/forum/viewforum.php?f=4&sid=43b2c8226f51b57421916ba9ea9fb521

Parkinson’s Disease and Constipation
http://www.nutritionucanlivewith.com/tape.htm

Parkinson’s: What You Can Do to Prevent and Relieve Constipation http://www.parkinson.ca/pdf/constipationEnglish.pdf

Comments

[Carolyn Zeiger]

Thank you, Kate, for always taking on the difficult topics, even when they "aren't dinner table conversation."

When my husband was diagnosed with PD, the first thing my cousin, the board certified MD gerontologist, told him was that constipation is a problem for everyone with PD, and can become a serious medical condition if you don't deal with it.

Typically, PD is referred to as a movement disorder. Recently, however, neurologists are talking more about autonomic nervous system symptoms like the sudden onset of constipation, being the first signs of PD.

What's more, for some people, these symptoms can be more problematic than the movement disorder. So it is important to learn what they are and how to deal with them.

Thinking of the children's book Everybody Poops, the PD person's version must be Everybody Poops--but me.

Carolyn Allen Zeiger, Ph.D.